Changes in pharyngeal aerobic microflora in oral breathers after palatal rapid expansion

Pediatric maxillary expansion has a positive impact on hearing? A systematic review and meta-analysis

OBJECTIVE

Hearing loss is a highly prevalent condition in the pediatric population. Pediatric maxillary expansion is a widespread treatment to address transverse maxillary deficiency. First reports describing an association between improvements for patients with HL and PME initiated in the 1960s. In this systematic review and meta-analysis we aim to review the role of maxillary expansion in reducing conductive hearing loss in pediatric population.

REVIEW METHODS

Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked. Main outcome was expressed as the difference between air-bone gap, compliance, ear volume and conductive hearing thresholds before and after treatment and the 95% confidence interval.

RESULTS

A total of 10 studies (218 patients) met inclusion criteria. The pooled data in the meta-analysis under a random effects model shows a statistically significant difference of 10.57dB mean reduction after palatal expansion. The air-bone gap was significantly reduced by 5.39dB (CI 95% 3.68, 7.10). Compliance and volume were assessed in three studies, with a non-significant positive difference in the compliance (0.14) and a statistically significant difference for volume (0.80) after palatal expansion.

CONCLUSION

This systematic review and meta-analysis found a positive effect of pediatric maxillary expansion in conductive hearing loss in well-select children. However, results cannot be extrapolated for children with conductive hearing loss without an accompanying orthodontic indication (maxillary constriction). It showed that the existing prospective studies exhibited qualitative pitfalls, limiting the ability to obtain conclusive evidence about the role of pediatric maxillary expansion on conductive hearing loss in children.

An alternative treatment approach for patients with resistant otitis media with effusion and dysfunctional Eustachian tube

OBJECTIVES

To determine whether dysfunctional Eustachian tubes of children with resistant otitis media with effusion (OME), ventilation tube placement indication, and maxillary constriction will recover after rapid maxillary expansion (RME).

MATERIALS AND METHODS

The RME group consisted of 15 children (mean age: 10.07 years) with maxillary constriction, Eustachian tube dysfunction (ETD), and resistant OME. The control group consisted of 11 healthy children (mean age: 8.34 years) with no orthodontic and/or rhinologic problems. Recovery of Eustachian tube dysfunction was evaluated by Williams' test at three timepoints: before RME/at baseline (T0); after RME (T1); and after an observation period of 10 months (T2). The control group was matched to all these periods, except T1.

RESULTS

In the control group, functioning Eustachian tubes were observed in all ears at baseline (T0), and tubes showed no worsening and no change during the observation period (T2) (P > .05). In the RME group, functioning Eustachian tubes were observed in eight of 30 ears and ETD was observed in the remaining 22 ears at baseline (T0). The RME group showed significant improvements in tube functions after RME and the observation period (P < .05). Fifteen of 22 dysfunctional ears recovered (68.2%) and started to exhibit normal Eustachian tube function after RME (T1) and the observation period (T2).

CONCLUSIONS

The findings suggest that ears having poorly functioning Eustachian tubes are restored and recovered after RME in most of children with maxillary constriction and resistant OME. Thus, RME should be preferred as a first therapy alternative for children with maxillary constriction and serous otitis media.

Can rapid maxillary expansion cause auditory improvement in children and adolescents with hearing loss? A systematic review

OBJECTIVE

To evaluate whether the use of palatal expansion techniques can influence hearing loss in children and adolescents with previous hearing impairment.

MATERIALS AND METHODS

Electronic searches in PubMed, Scopus, Web of Science, The Cochrane Library, Lilacs, OpenGrey, and Google Scholar were performed with a controlled vocabulary and free-text terms relating to palatal expansion and hearing loss. No language or time restrictions were imposed. Clinical trials that focused on human patients treated with rapid or semirapid maxillary expansion in children and teenagers with hearing loss were included. Data extraction was undertaken by two authors, with conflict resolution by a third author. Risk of bias assessment and data extraction were performed on the selected studies.

RESULTS

Seventy-four citations were retrieved by the search. Initially, 12 studies were selected according to the eligibility criteria, but three studies were excluded because of the presence of adults, absence of hearing level evaluation, and oversampling, resulting in nine studies. The mean improvement in hearing levels varied from 2 to 19 dB among the studies. The risk of bias varied from low to moderate risk.

CONCLUSIONS

The evidence indicated that there was a hearing improvement after maxillary expansion in patients with hearing loss in the evaluated studies, although more controlled and randomized studies are necessary to investigate this issue further.

Rapid maxillary expansion versus middle ear tube placement: Comparison of hearing improvements in children with resistance otitis media with effusion

OBJECTIVE

To test the null hypothesis that there are significant differences in hearing improvements of children with resistance otitis media with effusion (OME) who undergo a rapid maxillary expansion (RME) procedure or ventilation tube placement.

METHODS

Forty-two children between 4.5 and 15 years old were divided into three groups: RME, ventilation tube, and control groups. The RME group consisted of 15 children with maxillary constriction and resistance OME that indicated ventilation tube placement. The ventilation tube group consisted of 16 children for whom ventilation tube placement was indicated but no maxillary constriction. The control group consisted of 11 children with no orthodontic and/or rhinologic problems. Hearing thresholds were evaluated with three audiometric records: (1) before RME/ventilation tube placement (T0); (2) after RME/ventilation tube placement (T1), and (3) after an observation period of 10 months (T2). The control group was matched to these periods, except T1.

RESULTS

Hearing thresholds decreased significantly in both the RME and ventilation tube groups (P < .001). Hearing thresholds decreased approximately 15 and 17 decibels in the RME and ventilation tube groups, respectively, but differences in improvements were insignificant between the two study groups (P > .05). Slight changes were observed in the control groups.

CONCLUSION

The null hypothesis was rejected. RME showed similar effects as ventilation tube placement for release of otitis media and improvement of hearing thresholds levels. RME should be preferred as a first treatment option for children with maxillary constriction and resistance OME.

Effects of rapid maxillary expansion on nasal mucociliary clearance

OBJECTIVE

To evaluate the changes in nasal mucociliary clearance in orthodontic patients after rapid maxillary expansion (RME) therapy.

MATERIALS AND METHODS

Forty-two children (25 boys and 17 girls) participated in this study. The RME group consisted of 21 patients (mean age, 13.8 years), who had undergone RME at the initiation of orthodontic treatment. The control group consisted of 21 subjects (mean age, 13.6 years), who were attending the department of orthodontics for active orthodontic treatment. The nasal mucociliary clearance was assessed by the saccharin test. Saccharin transit times (STTs) were measured for each treated subject before expansion (T1), after RME (T2), and after a 3-month retention period (T3). Records were obtained at the same time intervals for each group.

RESULTS

The STT decreased significantly in the RME group after expansion and retention (P < .05). A statistically significant difference was found when the STTs of the control and RME groups were compared after expansion and retention (P < .05).

CONCLUSIONS

The STTs of young orthodontic patients with maxillary narrowness and without any history of nasal or systemic disease were within normal limits. However, RME increased the mucociliary clearance in patients who had maxillary narrowness, having positive effects on nasal physiology and increasing nasal cavity volume.

Oropharyngeal airway changes after rapid maxillary expansion: the state of the art

The aim of this article is to elucidate the state of the art about how rapid maxillary expansion (RME) produces changes in the oropharyngeal airways in terms of CBCT (Cone Beam Computed Tomography) data during the growth period, according to the available literature. Electronic search was done from January 2009 to April 2014 on PubMed and Scopus databases; in addition manual search was conducted as well. According to keywords, seven papers were eligible for our purpose, but definitely five papers were selected in agreement with the inclusion/exclusion criteria. The current literature suggests that the potential relationship between RME and oropharyngeal airway changes is still unclear. In fact, although the pharyngeal airway changes after the rapid palatal expansion are evident clinically, current orthodontic literature does not provide conclusive evidence about the nature of this relationship.

[Maxillary orthopedics and sleep-related respiratory disorders in children]

Early maxillary orthopedics can improve jaw relations and the jaw-skull base relationship. The objectives are clear: to correct the shape and improve function. A better proportioned skeletal framework is achieved, in which the underlying soft tissues become more resistant to collapse.

Efficacy of silver diamine fluoride for Arresting Caries Treatment

Arresting Caries Treatment (ACT) has been proposed to manage untreated dental caries in children. This prospective randomized clinical trial investigated the caries-arresting effectiveness of a single spot application of: (1) 38% silver diamine fluoride (SDF) with tannic acid as a reducing agent; (2) 38% SDF alone; (3) 12% SDF alone; and (4) no SDF application in primary teeth of 976 Nepalese schoolchildren. The a priori null hypothesis was that the different treatments have no effect in arresting active cavitated caries. Only the single application of 38% SDF with or without tannic acid was effective in arresting caries after 6 months (4.5 and 4.2 mean number of arrested surfaces; p < 0.001), after 1 year (4.1 and 3.4; p < 0.001), and after 2 years (2.2 and 2.1; p < 0.01). Tannic acid conferred no additional benefit. ACT with 38% SDF provides an alternative when restorative treatment for primary teeth is not an option.

Effects of rapid maxillary expansion on nasal breathing and some naso-respiratory and breathing problems in growing children: a literature review

OBJECTIVE

Rapid maxillary expansion (RME) is a dentofacial orthopedic treatment procedure which has been routinely used in young patients. Main goal of RME is to correct the existing posterior crossbite and to widen the maxilla and maxillary dental arch. However, a concomitant and contributing benefit of this procedure is an improvement on nasal airway which facilitates nasal respiration. RME brings about not only an increase in nasopharyngeal airway dimensions and an improvement in nasal respiration but also a decrease in naso-respiratory problems of the patients having maxillary constriction and mouth breathing. The purpose of this article is to review the effects of RME on naso-respiratory and breathing problems caused by maxillary constriction and mouth breathing in growing children.

CONCLUSION

Although orthodontic treatment is carried out to correct dental and skeletal discrepancies, some authors showed that treatment outcomes of RME could also effective on naso-respiratory and sleep-disordered breathing problems of the growing children. However, it must be kept in mind that this respect of RME was evaluated in a little number of studies and had a low-level of evidence.

Effects of Rapid Maxillary Expansion on Conductive Hearing Loss

Objective: To test the null hypothesis that rapid maxillary expansion (RME) with a rigid bonded appliance has no effect on conductive hearing loss (CHL) in growing children.

Materials and Methods: Fifteen growing subjects (mean age 13.43 ± 0.86 years) who had narrow maxillary arches and CHL participated in this study. Three pure-tone audiometric and tympanometric records were taken from each subject. The first records were taken before RME (T1), the second after maxillary expansion (T2) (mean = 0.83 months), and the third after retention (mean = 6 months) and fixed appliance treatment (approximately 2 years) periods (T3). The data were analyzed by means of analysis of variance (ANOVA) and least significant difference (LSD) tests.

Results: Hearing levels of the patients were improved and air-bone gaps decreased at a statistically significant level (P &lt; .001) during active expansion (T2–T1) and the retention and fixed appliance treatment (T2–T3) periods. Middle ear volume increased in all observation periods. However, a statistically significant increase was observed only in the T2–T3 period. No significant change was observed in the static compliance value.

Conclusions: The hypothesis is rejected. RME treatment has a positive and statistically significant effect on both improvements in hearing and normal function of the eustachian tube in patients having transverse maxillary deficiency and CHL.

Oral breathing and head posture

OBJECTIVE

To determine the head posture and cephalometric characteristics in oral breathing children.

MATERIALS AND METHODS

Lateral cephalograms taken in natural head posture of 35 oral breathing patients (OB) (mean age 8.8 +/- 2.2 years SD; range 5-13 years) and of 35 patients with varied malocclusions and physiological breathing (PB) (mean age 9.7 +/- 1.6 years SD; range 7-13 years) were examined.

RESULTS

A Student's t-test showed that an increase in angles NSL/OPT (P = .000), NSL/CVT (P = .001), FH/OPT (P = .000), FH/CVT (P = .005), and NSL/VER (P = .000); a decrease in the distance MGP-CV1p (P = .0001); and a decrease in the angles MGP/OP (P = .000) and OPT/ CVT (P = .036) were found in the OB group. A low position of the hyoid bone (H-MP, P = .009), a major skeletal divergence (ANS-PNS/Go-Me, P = .000), and an increased value of the ANB angle (P = .023) were present in OB patients. To ascertain if the changes in posture were connected with posterior obstruction of the upper respiratory airways, the OB group was divided into two subgroups based on the distance Ad2-PNS being greater than or less than 15 mm. No significant differences were found between these two groups.

CONCLUSIONS

Our data suggest that OB children show greater extension of the head related to the cervical spine, reduced cervical lordosis, and more skeletal divergence, compared with PB subjects.